Ibrah I: Pregnancy Problems

Pregnancy, Childbirth, & the Puerperium

{"ops":[{"insert":"Clinical Reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Decision 1: evaluation of microcytic anemia"},{"insert":"\n","attributes":{"header":2}},{"insert":"Ibrah has presented with a mild microcytic hypochromic anemia. Blood films additionally reveal anisopoikilocytosis, while reticulocyte counts are not elevated. Considered together, these findings are most suggestive of iron deficiency anemia. However, as she is of an ethnic group with a predisposition for thalassemia it is justifiable to rule this out via hemoglobin electrophoresis or high performance liquid chromatography. \n\nNote that both vitamin 12 deficiency and folate deficiency give rise to a macrocytic anemia. Thererefore, there is little justification for assessing serum vitamin B12 or folate levels.\nDecision 2: prenatal screening for chromosomal abnormalities"},{"insert":"\n","attributes":{"header":2}},{"insert":"First trimester screening for chromosomal abnormalities should be offered to all women regardless of age or past history, where resources permit.\n\nCombined first trimester screening is an appropriate choice. This includes a nuchal translucency (NT) scan, free beta human chorionic gonadotropin (\u03b2-hCG) levels, and pregnancy associated plasma protein A (PAPP-A) levels.\n\nNon-invasive prenatal testing has traditionally been considered a diagnostic test that should be performed if screening is positive. However, certain authorities recommend it for first-line screening, as it is highly sensitive and specific for the detection of "}]}

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